Neurological diseases - main types and who to contact for their treatment?

Neurology is a branch of medicine that studies the nervous system: structure, function, norms and pathologies, influence on other organs and systems, as well as its treatment. This industry is closely related to such medical disciplines as: anatomy, physiology, neurogenetics, angiology, psychiatry.

The Neurology Clinic of the Yusupov Hospital provides diagnosis and treatment of diseases of the nervous system, as well as rehabilitation of patients with neurological ailments. Modern medical equipment and the latest treatment methods allow neurologists to establish an accurate diagnosis and select treatment tactics individually.

Types of Neurological Diseases

Clinical classification of pathologies of the central and peripheral nervous system:

1. Vascular diseases of the brain (transient and progressive cerebrovascular accidents, strokes).
2. Epilepsy (partial and generalized seizures).
3. Infectious diseases of the nervous system (meningitis, myelitis, encephalitis, epiduritis, poliomyelitis, multiple sclerosis).
4. Diseases of the peripheral system (vertebrogenic pathologies, lesions of nerve roots, nerves, cranial nerves).
5. Tumors of the central nervous system (gliomas, neoplasms of the spinal and cranial nerves, meninges, pituitary gland).
6. Pathologies of the autonomic nervous system (migraine, neuroses, hereditary neuropathies, systemic and autoimmune diseases).
7. Injuries of the central nervous system (craniocerebral, spinal cord).
8. Headache (tension headaches, cluster headaches, migraine, pain associated with metabolic or vascular disorders, cranial neuralgia).
9. Hereditary degenerative diseases (Huntington's chorea, Refsum's disease, Gaucher's disease, Marfan's disease, myasthenia gravis).
10. Diseases of the nervous system of childhood and developmental defects (cerebral palsy, hydrocephalus).
11. Impaired consciousness (stupor, coma).

Brain diseases

Neurological diseases of the brain can be identified as a separate group These include, for example, a brain abscess. This is a disease in which pus accumulates in a limited area inside the skull. The symptoms of various types of abscesses (and they are epidural, intracerebral and subdural) depend on the size of the abscess and its location. The diagnosis is made using modern methods: MRI and CT . Small abscesses can be treated conservatively; large formations require the intervention of a neurosurgeon.

Benign brain tumors include pituitary adenoma (the tumor originates from the anterior lobe of the pituitary gland). Ocular neurological syndrome , one of the representatives of numerous neurological syndromes, manifests itself very clearly here. There are disturbances in oculomotor function, visual fields are narrowed, headaches and double vision are common. Endocrine metabolic syndrome also manifests itself in this type of tumor. It can be expressed in acromegaly, dysfunction of sexual function, thyroid function, etc. For diagnosis, the neurologist uses X-ray data, CT of the so-called “sella turcica,” cerebral angiography, and MRI. The diagnosis is confirmed by hormone tests and an eye examination by an ophthalmologist.

Although pituitary adenoma is considered a benign tumor, it brings a lot of suffering to patients. For example, with gigantism, a person already in adolescence has enormous height, and if acromegaly is added to this, then he will have prohibitively large hands, feet, and face. Treatment is carried out by radiation exposure, the radiosurgical method is used. Most often, a pituitary adenoma is removed through the nose (transnasally), but there is also a transcranial way of getting rid of the tumor.

What other diagnoses does a neurologist make? This is, for example, a cerebral aneurysm . This name is given to local protrusions of the walls of the cerebral arteries. If the aneurysm “behaves” like a tumor, then a mass formation in the brain will be observed. In another course of the disease, there may be hemorrhages resulting from a rupture of an aneurysm. A neurologist makes a diagnosis after taking a history, neurological examination, X-ray examination of the skull, analysis of cerebrospinal fluid, as well as CT and MRI data. An aneurysm is most often treated with surgery.

Signs of a neurological disorder also appear with abnormalities in brain development. Such anomalies are treated symptomatically: the neurologist prescribes antiepileptic drugs, and also applies metabolic and psychocorrective treatment.

Diseases of the nervous system and their symptoms

Neurologists often have to treat migraines, neuralgia, neuritis, vegetative-vascular dystonia, neuroses, and neuropathies. They are treated with Alzheimer's disease, Parkinson's disease, cerebral palsy, degenerative diseases of the spine, epilepsy, and insomnia. Specialists diagnose and treat encephalitis, meningitis, epilepsy, consequences of stroke, and head injury.

Diseases of the nervous system manifest themselves in a number of syndromes:

• vegetative (dizziness, breathing problems, tachycardia, changes in blood pressure);
• motor (tremors, convulsions, paralysis, paresis, numbness of body parts);
• pain (headache, discomfort in the heart, neuralgia);
• general (increased fatigue, decreased performance, deterioration of memory and concentration, hearing and vision impairment, loss of consciousness, nausea, vomiting, bowel disorders, problems falling asleep and waking up at night, tinnitus, mood swings, speech disorders, panic attacks, phobias) .

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Diagnosis and principles of treatment of diseases of the nervous system

To make a diagnosis, a neurologist examines and interviews the patient and collects anamnesis. The doctor checks reflexes using special neurological tests. To obtain an objective picture of the disease, the patient undergoes laboratory tests (blood, lumbar fluid) and undergoes instrumental diagnostics, including:

• encephalography;
• angiography;
• electrocardiography;
• computed tomography;
• Dopplerography of blood vessels;
• magnetic resonance imaging;
• electroneuromyography;
• neurosonography;
• Doppler ultrasound;
• polysomnography.

Depending on the patient’s condition, treatment measures can be:

• urgent (aimed at restoring human life);
• medications that serve to maintain vital functions (for example, for patients in a coma);
• medications, which are aimed at accelerating the restoration of nerve connections, improving nerve conduction, as well as courses of neuroprotectors, muscle relaxants, antidepressants, vitamins, specific drugs for infections, tumors;
• surgical (surgical interventions to remove tumors, restore vascular patency, treat malformations and consequences of injuries);
• physiotherapeutic (massage, exercise therapy, manual therapy, acupuncture, ultrasound and magnetic therapy, electrical stimulation, UHF);
• rehabilitation (after brain and spinal injuries, after a stroke, with multiple sclerosis and Alzheimer's disease).

Different neurological diseases require different approaches to therapy. Neuralgia and VSD can be treated at home. In case of acute cerebrovascular accidents (stroke), immediate hospitalization in a neurological hospital is required. Recovery from concussions and injuries is carried out in specialized rehabilitation centers.

Functional disorders in neurological practice

G.M. DUKOVA

, Doctor of Medical Sciences, Professor,
First Moscow State Medical University named after.
THEM. Sechenov The article discusses the main clinical manifestations, approaches to diagnosis and modern methods of treating functional disorders.

More than 30% of patients visiting a neurologist complain of somatic symptoms that cannot be explained by any organic disease [19, 20]. Such patients are often recommended expensive research and treatment, consultations with various specialists, which, as a rule, do not lead to a positive result, causing dissatisfaction for both the patient and the doctor [1]. The most common disorders in this category of patients are tension headaches and other chronic pain syndromes, conversion disorders, hyperventilation syndrome, dizziness, asthenia, depression, anxiety and somatoform disorders [16, 19].

In domestic medicine, such disorders are most often referred to as “vegetative dystonia syndrome” (G-90.9) or “astheno-neurotic reactions”; in therapeutic practice the term “neurocirculatory dystonia” is used. Some authors use the term “psychovegetative syndrome”, proposed in the 60s of the last century by German internists [2].

In foreign literature there is also no uniform terminology to refer to this group of disorders. In recent decades, authors have increasingly resorted to terms such as “medically unexplained symptoms” [18] or “subjective health complaints” [22], however, these are not satisfactory, because they are based not on positive, but on negative criteria.

Recently, it has been proposed to use the term “functional” and designate disorders in the somatic sphere with the term “functional somatic symptoms”, and in the neurological sphere with the term “functional neurological symptoms”. The advantage of this term is its “positive” meaning and patient acceptability, since dysfunction is emphasized, there is no definition of “unexplained” that worries the patient, as well as the mention of a psychogenic factor, which usually causes internal resistance of the patient, even if this is not realized by the patient.

Main clinical manifestations of functional disorders:

— Autonomic (permanent and paroxysmal) — Chronic pain syndromes — Motivational — Functional-neurological — Emotional-affective — Behavioral

Autonomic disorders

The main characteristic of autonomic disorders is their polysystemic nature. Table 1

The main manifestations of autonomic disorders are presented.

Analysis of the semiotics of autonomic disorders requires determining the type of their course: permanent and/or paroxysmal. Permanent autonomic disorders mean subjective and objectively recorded disorders of autonomic functions that are permanent or occur sporadically. These disorders may manifest predominantly in one system or have a distinct multisystem nature.

Paroxysmal autonomic disorders, autonomic crises or panic attacks (PA) are the most striking and dramatic manifestation of the psychovegetative syndrome.

The following criteria are used to diagnose panic disorders:

1. Sudden, sometimes unexpected appearance of 4 or more symptoms: - vegetative (cardiovascular, respiratory, vasomotor, etc.); - vestibular (dizziness, instability, etc.) - emotional-affective (panic, fear, aggression, etc.) - dissociative (derealization, depersonalization) 2. Anticipation and repetition of these episodes 3. Constant worry about the consequences of attacks 4. Behavior changes in connection with panic attacks (agoraphobia and restrictive behavior) 5. The appearance of attacks regardless of any organic factor (for example, caffeine intoxication or hyperthyroidism).

Attacks consisting of several symptoms are called “abortive” or “minor”. If during an attack the patient experiences most of the above symptoms, then they speak of “extended”, “large” PA.

There are several types of PA depending on the dominant symptoms: respiratory, vestibular, cognitive and “non-insured”, as well as by the time of occurrence: night/day attacks [9].

Outside of attacks, agoraphobic syndrome is most often observed, which ultimately manifests itself as fear of a situation potentially threatening the development of PA and difficulty in obtaining medical care. Such situations can be being in a crowded room, in a store, transport, cinema, alone at home or in the country. Agoraphobia is the factor that determines the psychological and social consequences of PA, namely restrictive behavior and secondary depression. It is these consequences that are the target for therapeutic interventions (psychotherapy and psychopharmacotherapy).

Chronic pain syndromes

In clinical practice, chronic pain syndromes make up a significant proportion of patients. Beyond the clearly defined somatogenic and neuropathic pain, there are a variety of chronic pain syndromes labeled as “functional,” “medically unexplained,” “dysfunctional,” “somatoform,” “somatized,” “psychogenic,” etc.

Chronic pain syndromes observed in clinical practice

— Headaches — Atypical facial pain — Pain in the left side of the chest (“non-cardiac pain”) — Back pain — Abdominal pain — Pain in the lower abdomen (pelvic pain) — Anogenital pain — Pain throughout the body (fibromyalgia) Currently the above chronic pain syndromes of different localization, together with other symptoms (mental, autonomic, motivational and neuroendocrine) are regarded as functional based on common factors that are naturally observed in all these forms. These include: the frequent combination of different syndromes in the same patient, both simultaneously and sequentially, the predominance of women, emotional disorders and a history of childhood psychotrauma, the leading role in the pathogenesis of these syndromes of dysfunction of certain cerebral systems (limbic parts of the brain, prefrontal and parietal cortex ) and the therapeutic effectiveness of antidepressants.

Currently, there are 2 groups of factors that are involved in the chronicization of pain syndromes: biological and psychosocial, the structure of which is presented in Table 2

.

Diagnosis of chronic pain syndrome includes the following:

1. Exclusion of possible somatic (organic) factors causing pain. 2. Clarification of the temporal characteristics of pain. Duration of pain: most of the day, at least 15 days per month, lasting at least 6 months. 3. Qualitative characteristics of pain: monotonous pain, periodically intensifying before an attack, in the description of pain the use of non-pain terms (“cotton head”, “stuffiness” in the left half of the chest, “unpleasant tickling” in the lumbar region, etc.), senestopathic coloring of pain. 4. The localization of pain during examination and palpation is always much wider than the patient presents. 5. Painful behavior - marking a “sick” organ - immobilizing it, constantly rubbing the skin in the heart area, regularly taking analgesics, and if they have no effect, regularly calling an ambulance. 6. Psychogenesis of pain. Presence of close relatives suffering from pain. Often the patient himself experienced pain, or observed it in emotionally charged situations, for example, the death of a parent from a myocardial infarction with severe pain. 7. Beaten paths. Debut or exacerbation of chronic pain after injuries, surgical interventions, infectious diseases. 8. Syndromic environment, including psychovegetative and motivational disorders.

Functional neurological symptoms

This term refers to neurological symptoms that do not have an underlying organic cause. In the practice of a neurologist, such symptoms account for up to 19% of outpatient visits [16] and 9% of hospitalized patients [10]. In modern classifications, they belong to the headings of “dissociative (conversion)” disorders in ICD-10 or “somatoform” disorders in DSM-IV.

The clinical phenomenology of functional neurological disorders (FNS) is presented as follows:

1. Paralysis and paresis 2. Paroxysmal disorders (seizures) 3. Gait disorders 4. Sensory disorders 5. Visual and oculomotor disorders 6. Dyskinesia 7. Speech and voice disorders 8. Impairments of consciousness 9. Cognitive impairments

Functional neurological disorders can be observed both in the structure of PA and in the permanent version. A special study showed that in the structure of a typical panic attack, up to 30% of symptoms can be classified as FNS [23]. Often they are the subject of special concern for relatives and diagnostic errors of doctors.

Diagnosis of these disorders requires special awareness of the typical neurological manifestations of hysteria, as well as the use of specific tests and samples [25, 21].

Violation of biological motivations

There are 4 basic biological motivations that are basic for preserving life, the full functioning of the body and procreation. These include the need for food intake, the need for sleep and sexual activity. Separate and important for human existence is the need for activity, action, participation in society, etc. The mechanisms of motivation at the cerebral level are primarily associated with the activity of the limbic-reticular complex systems, which regulate adaptive behavior in response to any type of stress.

With functional disorders, disturbances occur in the sphere of motivation. Their syndrology is presented below:

— Eating disorders (anorexia with weight loss or bulimia with weight gain) — Dissomnia disorders (difficulty falling asleep, early awakenings, shallow sleep, hypersomnia, parasomnia) — Sexual disorders (decreased libido, potency, anorgasmia, etc.) — Asthenia (weakness, fatigue) As a rule, patients do not focus attention on them, but with active questioning it is possible to reveal that “there is no appetite, and even the smell of food causes nausea” or, conversely, “you constantly want to eat and even have to get up at night to do this” , patients often talk about certain sleep disorders. Problems in the area of ​​intimate life often appear before the onset of the disease, and during the course of the disease, sometimes sexual life “comes to naught.”

Separately, it is necessary to dwell on the violation of motivation for activity. Clinically, this manifests itself as asthenic syndrome. Asthenic syndrome is one of the most common syndromes in the clinical practice of any doctor. The key words in asthenia are “weakness” and “fatigue,” which are characterized by the fact that they occur not only with exertion, but also without it, and do not go away after rest. Since the feeling of fatigue is a key trigger for rest, the essence and meaning of the feeling of fatigue and weariness is an urge to stop activity, activity, any effort, etc. Reducing activity is a universal psychophysiological mechanism for preserving the vital activity of the system in the event of any threatening situation, operating according to the principle : less activity means less energy requirement. With asthenia, not only the real threat of depletion of energy reserves, but also an imaginary threat (emotional overstrain, stress, conflicts) are triggers for feelings of fatigue and weakness. It has been shown that changes in the sphere of motivation are key to the formation of asthenia in humans [26, 27, 6].

Emotional, affective and behavioral disorders

Patients with functional disorders usually turn to a neurologist with specific somatic complaints, such as pain, dizziness, shortness of breath, lump in the throat, sleep disturbances, etc. and, as a rule, do not complain about emotional disorders and do not associate symptoms that worry them with them. Moreover, they regard even fear in the structure of PA as secondary to “increased pressure,” “choking,” “palpitations,” or “dizziness.” This is what causes misdiagnosis and inadequate treatment. The identification of emotional disorders is complicated by the alexithymia inherent in such patients. Alexithymia refers to the patient’s difficulty in recognizing, expressing and describing (verbalizing) his own feelings, state of mind and emotions experienced by himself or other people, as well as difficulties in distinguishing between emotions and bodily sensations. Psychometric tests are usually used to identify emotional disorders and alexithymia. However, clinically it is also possible to get an idea of ​​the patient’s disturbing thoughts, threats, perceptions and associated emotions. To do this, it is enough to purposefully ask the patient how he behaves at the moment the symptom appears, in what situation the symptom appears, how the symptom affects his physical and social functioning, what actions the patient takes to avoid the “consequences of the disease” he imagines. It is often possible to identify distinct restrictive behavior, repeated tests that bring relief for a short time, obsessive rituals (constant measurement of blood pressure, precautionary use of painkillers), etc.

Thus, in the practice of a neurologist, many patients experience a variety of autonomic, neurological, motivational and behavioral disorders, in which all available research methods do not reveal an organic cause and which today are designated as functional disorders.

Therapy for functional disorders

The vast majority of patients with functional disorders are observed and treated either by neurologists or general practitioners. The dominance of asthenia, pain and autonomic syndromes in the clinical picture, the hidden nature of emotional disorders often prompts doctors to use predominantly somatotropic drugs in therapy: antihypertensive and vegetotropic drugs, analgesics, vascular-metabolic therapy, antioxidants, adaptogens, etc. And only in the case of obvious For emotional disorders, tranquilizers may be included in therapy. Such therapy often turns out to be ineffective, undermining the patient’s faith in the possibility of a cure and contributing to the chronicity of the process.

Already at the first contact, the doctor must determine the further strategy for managing the patient. At the first stage, it is absolutely necessary to exclude an organic disease, which can manifest itself with similar symptoms. A detailed clinical and paraclinical examination of the patient also has a psychotherapeutic value, showing the seriousness of the doctor’s attitude towards the patient and objectively convincing the patient of the absence of a threatening disease.

Despite the fact that pain and autonomic disorders are the most obvious in the clinical picture, psychopharmacology is currently the basic method of treatment. Psychotherapy also plays a significant role.

The main goals of therapy for functional disorders are:

1. Relief of the leading symptom or syndrome 2. Impact on secondary syndromes (agoraphobia, depression, anxiety, asthenia). 3. Prevention of relapses and further progression of the disease. For this purpose, symptomatic, pathogenetic and preventive therapy is used. Sometimes an explanatory conversation with a doctor about the essence of the disease, possibly in combination with placebo therapy, is sufficient. Our studies have shown that in 35-42% of patients suffering from panic disorder, significant improvement was achieved only with the help of placebo therapy [4].

Symptomatic therapy

aimed at quickly relieving the leading symptom. This stage of therapy has several goals. Firstly, rapid relief of the patient’s condition, which in itself has a psychotherapeutic effect, since it removes the fear of a threatened and incurable disease. Secondly, relief of the leading symptom prevents the process from becoming chronic. Thus, rapid and early relief of acute back pain prevents the development of persistent muscle spasm, which is an important pathogenetic mechanism for the formation of chronic back pain. Early and successful relief of panic attacks prevents the development of agoraphobic syndrome and restrictive behavior, which are the main factors of social disability in patients with panic disorders.

Symptomatic therapy can be represented by a variety of techniques. Thus, to relieve hyperventilation disorders, it is advisable to teach the patient breathing exercises, which he can use both to relieve panic attacks and to correct respiratory disorders outside of an attack. For most functional symptoms, pharmacological drugs are used as symptomatic therapy - the so-called “treatment on demand”: to relieve nausea - prokinetics (cerucal), to reduce tachycardia - beta-blockers, to relieve pain - non-steroidal anti-inflammatory drugs and muscle relaxants, for relief paroxysms (panic attacks) - tranquilizers. It is necessary to remember and explain to the patient that this treatment operates on the “here and now” principle and is a short-term therapy, which will be canceled as the main pathogenetic therapy takes effect. Moreover, the patient’s healing process is characterized by a decrease in the need for these “life-saving” drugs. Often the patient himself does not yet realize a noticeable improvement in his condition, and the doctor can make him understand this if in a conversation he focuses the patient’s attention on the number of symptomatic medications taken in the last week. Thus, the effectiveness of pathogenetic therapy is substantively proven to the patient.

Pathogenetic therapy

is focused on preventing the reappearance of paroxysmal manifestations (panic attacks, psychogenic seizures, pain attacks, etc.), regression of the abusive factor, relief of anticipation anxiety, agoraphobic syndrome and restrictive behavior, secondary depression, asthenia and other motivational disorders.
Therapy aimed at the formation of new patterns and stereotypes
of motor behavior, cognitive aspects of thinking, motivation, emotional-affective and behavioral reactions is important.

Numerous multicenter placebo-controlled studies have shown that antidepressants (ADs) are the basic drugs in the treatment of functional disorders. It has been found that AD can be effective in chronic pain syndromes of various localizations [3], panic disorders [8, 7, 17], asthenia [15] and appetite disorders [11]. Moreover, ADs are effective regardless of whether these syndromes are combined with depression or not, and the doses used for the treatment of functional disorders are lower than for the treatment of depression.

It should be noted that the pronounced side effects of a number of ADs, in particular tricyclic ADs, significantly reduce the possibility of their use, especially in outpatient practice. Therefore, the drugs of first choice are currently drugs from the group of selective serotonin reuptake inhibitors - SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram and escitalopram).

Escitalopram belongs to the second generation of SSRIs, since it has a slightly different mechanism of action than other serotonergic antidepressants: it interacts not only with the primary binding locus of the serotonin transporter protein, but also with the secondary (allosteric) one, which leads to faster, more powerful and persistent blockade of serotonin reuptake due to the modulating effect of allosteric binding. At the same time, escitalopram is the most selective of the SSRI antidepressants, since it practically does not bind to serotonin (5-HT), dopamine (D-1 and D-2), α-adrenergic, histamine, m-cholinergic receptors, as well as benzodiazepine and opiate receptors. receptors [14].

M. Mazza et al. [12] revealed the effectiveness of escitalopram at a daily dose of 20 mg in the treatment of chronic lumbar pain. Therapy with escitalapram has been shown to be effective in patients with panic disorders [24]. Muller et al. studied the effectiveness of escitolapram in patients with “multisomatoform disorders,” which refers to “medically unexplained symptoms,” in a double-blind, placebo-controlled manner. At the 12th week of treatment, escitalopram was effective in 84.0% of patients, in contrast to 26.9% on placebo [13].

The most common side effects when taking escitalopram were nausea and headache, which were mild, transient and disappeared within 2-3 weeks. Escitalopram does not cause significant inhibition of the activity of the main isoenzymes of the cytochrome P 450 family in vitro, and therefore it is unlikely to be involved in clinically important pharmacokinetic drug interactions in patients.

Thus, high efficiency at a minimum dose, minor and quickly passing side effects, as well as the absence of drug interactions make escitalopram an indispensable drug in the treatment of elderly and somatically burdened patients. Treatment adherence in patients taking escitalopram is significantly higher than in similar studies with other antidepressants.

In 2014, a domestic generic version of escitalopram appeared on our market - the drug Asipi (JSC Veropharm). Based on comparative pharmacokinetics, it is shown that the drug Asipi is bioequivalent to the original drug Cipralex.

When determining the tactics of blood pressure therapy, it is necessary to resolve two main issues: choosing a drug and determining the dose.

The choice of drug is determined mainly by the clinical picture of the disease and the characteristics of the drug. When determining the dose of the drug, the following rules may be useful:

1. Taking into account the individual sensitivity and anxious suspiciousness of this category of patients, it is advisable to begin therapy with small doses (1/2-1/4 of the planned dose) with a gradual increase over 3-5 days. 2. The criterion for limiting the dose may be the severity of side effects that do not disappear within 3-5 days. 3. A daily distribution of the drug is recommended depending on the hypnogenic effect.

Before prescribing a course of drug therapy, the doctor must explain to the patient the basic principles of treatment and warn about possible difficulties in the treatment process. In this conversation, it is necessary to emphasize the following points:

1. The essence of the treatment is that it is aimed at preventing the recurrence of attacks and the social adaptation of the patient. 2. The effect of therapy may be delayed, since in most ADs the effect appears with a latent period of 14-21 days from the start of their use. 3. The course of treatment should be long, sometimes it can last up to a year. 4. Abrupt withdrawal of drugs at any stage of treatment can lead to exacerbation of the disease, therefore, at the end of treatment, drug withdrawal is carried out very gradually. Psychotherapeutic approaches to the treatment of functional disorders

can be conditionally divided into 3 types: 1) psychotherapy aimed at relieving individual symptoms and improving the general condition of the patient 2) aimed at pathogenetic mechanisms; 3) person-oriented (reconstructive) psychotherapy.

Symptomatic psychotherapy includes techniques aimed at influencing individual neurotic symptoms and the general condition of the patient. This is auto-training (in individual and group modes), hypnosis, suggestion and self-hypnosis. With the help of such techniques, anxiety is relieved, optimism and self-confidence are imparted, and the patient’s motivation for recovery is enhanced.

The second group includes cognitive behavioral psychotherapy, conditioned reflex techniques, body-oriented methods, and neurolinguistic programming. The main goal of cognitive behavioral therapy is to help the patient change the pathological perception and interpretation of painful sensations, since these factors play a significant role in the maintenance of symptoms. Cognitive behavioral therapy may also be useful in teaching the patient more effective coping strategies, which in turn may lead to increased adaptive capacity.

The third group consists of methods aimed directly at the etiological factor. The essence of these techniques is person-oriented psychotherapy with the reconstruction of the basic motivations of the individual. These techniques are aimed at revealing early childhood conflicts or current personality problems; their main goal is the reconstruction of personality. This group of methods includes psychodynamic therapy, Gestalt therapy, and family psychotherapy.

When functional disorders are combined with obvious hysterical, senesto-hypochondriacal, obsessive and/or phobic manifestations, small doses of antipsychotics are used as an addition to basic pharmacotherapy with antidepressants - Melleril (Sonapax), Theralen, Eglonil, Tiapridal, Chlorprothixene, Seroquel, Etaparazine, Neuleptil.

Non-drug therapy

Methods of non-drug therapy include information and educational programs, physical training, massage, therapeutic exercises, hydrotherapy (water gymnastics, swimming, contrast showers, Charcot shower), breathing exercises, acupuncture, complex treatment with thermo-, odorous, music and light effects carried out in a specially designed capsule, biofeedback methods, exposure to transcranial magnetic stimulation, etc. Thus, most modern researchers believe that physical activity is a priority in the treatment of asthenia. Empirical evidence and analysis of randomized controlled trials suggest that 12 weeks of graded exercise therapy, especially when accompanied by patient education programs, can significantly reduce feelings of fatigue and tiredness.

Thus, at present, a large group of patient complaints and physical symptoms are united on the basis of the absence of organic pathology and the presence of common pathophysiological mechanisms in their origin. Comprehensive treatment, in which the treatment of blood pressure is a priority, makes it possible to successfully cope with these socially disabling sufferings.

Literature

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Source

: Medical Council, No. 5, 2015

Preventive measures

Prevention allows you to prevent the development of neurological diseases, and also helps to maintain the achieved results in their treatment. Basic recommendations for all groups of patients (with congenital and acquired pathologies of the nervous system):

• consult a doctor promptly if alarming symptoms appear;
• undergo regular medical examinations (especially for previously diagnosed diseases of the nervous system, including those in remission);
• follow the principles of a healthy lifestyle (eat rationally, give up bad habits, regularly take walks in the fresh air);
• devote time to moderate physical activity (in the absence of contraindications);
• maintain a sleep-wake schedule;
• exclude or limit the effect of provoking factors (stress, high psycho-emotional stress);
• practice autogenic training to restore mental balance during stress and relieve emotional tension.

If you have symptoms of neurological disorders, as well as to get an alternative opinion on the treatment of such diseases, contact the neurologists of the Consultative and Diagnostic Center (formerly the National Diagnostic Center).

New in the treatment of nervous disorders abroad in women, men and children

Psychotherapy – thanks to group or personal consultations with a doctor, it is possible to develop competent behavior in circumstances of stress, overcome manifestations of disorders, change attitudes towards oneself, and the general state of affairs.

Relaxation techniques help reduce muscle tension, provide an opportunity to relax, and get rid of constant thoughts. Such techniques include the possibility of meditation, yoga, massage, certain types of treatment with mineral waters, color and aromatherapy.

Physical activity, a healthy lifestyle - the role of these components in the treatment of nervous disorders in women and men is only growing. Sports exercises improve mood, promote the quality of the cardiovascular system (significantly affected in nervous disorders), increase the production of serotonin (a neurotransmitter necessary for the quality of functioning of the brain), and improve sleep.

In addition, for such problems, as in the treatment of mental disorders, they resort to drug treatment, using in particular:

• Drugs with additional sedative effects. Many signs of a nervous disorder—head pain, rapid heartbeat—can be relieved with medications designed to solve a specific problem.
• Medicines based on plant extracts (valerian, motherwort, lemon balm, chamomile, etc.).
• Complexes of vitamins and minerals. In a stressful state, vitamins B, E, calcium, and magnesium are especially important.
• Homeopathic medicines, dietary supplements - most often they contain extracts of invigorating (ginseng) or calming (chamomile, lemon balm) effects.
• Prescription drugs are powerful drugs, they are prescribed by a doctor, and they are also taken only under medical supervision: antidepressants, antipsychotics, tranquilizers, which have a variety of side effects and a number of contraindications.
• Non-prescription drugs that have a complex therapeutic effect, improve sleep, memory, performance, mood, and relieve anxiety.